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Pediatrics/please, help! NO DIAGNOSIS FOR 2 MONTHS!! - baby with HIGH white blood cells in Cyprus

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QUESTION: Dear Doctor,
   My name is Galina Kirsanova (Galia). I’m Russian. I studied at the USC in 2004-2006; but then made the biggest mistake of my life & left for Cyprus (in the Mediterranean, the one with a recent crisis...). My daughter, Katie, born on 30/03/12 here (in Cyprus), is all I have in my life. & now she’s sick, and for over 2 months now doctors here cannot tell us what the diagnosis might be, just sending us for repetitive general blood tests, which I could send you to some contact email ...
   Please, Doctor, help us, tell me what it might be, or maybe you know some pediatrician / hematologist who could be so kind as to advise me on Katie's condition...   I really trust American doctors more (since I studied in the USA). I tried writing to several doctors at the USC Children's Hospital, but haven't got any reply from them... The Hospital advisor told me to fill in the International referral form. I'll certainly do that, but at present, I really cannot afford coming to the US without any preliminary diagnosis, because we’re all by ourselves here. We ran away from my violent substance-abusing husband 4 months ago & now really struggle. Of course, if I get at least 1 opinion from an American doctor, proposing that my daughter has a particular problem that has to be treated in the US, we'll do everything to get her over there).

   Here’s Katie brief medical history:

Current condition - 11/4/13 - runny nose started yesterday, just 1 week before had cough & 2 weeks ago - runny nose. had only been healthy for 1 week at most...NO fever. eats well, very active, plays.

LAST BLOOD TEST (10/25): WBC 25.29, RBC 5.07, NEUT 10.36, LYMPH 12.38, MONO 1.85, EO 0.64

MEDICAL HISTORY:
30/08   - infectious pimple on the leg got swollen & blown up (2 others on the arms, one by one, appeared & disappeared by themselves in the course of 2 weeks when I applied iodine betadine solution) + temperature 102 – went to hospital: white blood cells 700
until - 2/9 - at hospital, with intravenous antibiotics (constantly had IV on)
2/9 – discharged - white blood cells - 750

until 9/9  -antibiotic syrup Moxiclav Forte (Amoxicillin/Clavulanic Acid)
11/9 - no temperature, feels good, eats well, plays - 19500 white cells
15/9- caught cold, runny nose, cough, drinks milk well, finger feeds a little, doesn't want spoon food, still plays – I do her inhalers: Salamol (salbutamol sulphate), Atrovent (ipratropium bromide), Beclazone  (beclometasone Dipropionate)
17/9 - white cells 27000 - plays, clinically seems to feel ok (considering flu), cries a lot when I give her medicines (masks & nasal drops), drinks milk well, but doesn’t want spoon food, runs.

22/9 - new blood test results - 22000 white blood cells – but had flu then, then it ended, she felt OK &
29/9 – when she seemed to feel fine - blood test results - 22000 white blood cells again…

Please, Doctor, couldn’t you be so kind as to tell me what it might be? One day hopefully we’ll come back to LA & will thank you in person. I’m just very-very scared & regret my leaving from LA & being stuck here more than ever.


My phone is (+357) 97 621351, Skype: galiacy2.

I’ll be ever thankful to you.
Waiting anxiously for your reply.
Yours sincerely, Galia

ANSWER: Hi, Galia,

It is unclear to me why they keep on doing all the blood tests.  One is sick if one is feeling ill and simply repeating a lot of blood work makes no sense to me.  How is she sick at this time?  She may have asthma and this is what the three inhaled meds are for.  I really wonder why, on 11/9, with her feeling healthy and doing well, the blood count was performed.  I have a hard time reconciling a normal healthy kid with a blood test that is slightly high.  We don't treat most blood tests, we treat kids.

If I am missing something here, please tell me.  To me if she is growing well, developing fine, and generally is healthy, I wouldn't just routinely do blood tests.  

Good luck, Dr. Olson

---------- FOLLOW-UP ----------

virus tests
virus tests  
October 25 test
October 25 test  
QUESTION: Thanks a lot, Dr. Olson!
 I really appreciate an opinion from an American doctor - I just trust the U.S. medicine more. Never in my life have I regretted my leaving from the US than at this time...
 I was really worried. She's generally healthy, but she catches cold often (runny nose, cough).
 Could you, please, suggest anything that could explain Katie's high white blood counts (I have attached some of her tests if that could help - I have all of them starting from WBC 700. I could send them to some email of yours).
 Thank you so much!!  When one day we come back to the US , we'll come to thank you in person (or maybe some day you'll be travelling somewhere over here-:).
  Galia

ANSWER: Hi, Galia,

The viral studies are fine, and weakly positive EBV probably means nothing.  The WBC is high, but again, in the face of a child who is growing well and is developing fine, I personally wouldn't worry about it.  Why is it high? Could be she is just unfortunate to be getting repeated viral illnesses and this is causing her immune system to be stimulated to produce a lot of white blood cells.  The differential count, the type of white blood cells is unremarkable and not helpful.  

I would be happy to look at the rest of the counts and any other labs.  davesolson@gmail.com

Good luck, Dr. Olson

---------- FOLLOW-UP ----------

QUESTION: Dear Dr. Olson!
Sorry for bothering you, but I just would like to know if you had a chance to  take a look at Katie's blood tests that I sent to your email: <> on 11/11/13? Or is there something wrong with them??
I also had her vaccinated against flu...Do you think it's right?
Thank you very much in advance!
Best regards, Galia

Answer
Hi, Galia,

Looked these over and my feeling is still the same:  if she is healthy and has a slightly high WBC, I would not worry about it or pursue vigorously any other diagnosis.

Flu shots are pretty much essential this time of year and she should get hers.  Good decision!

Good luck, Dr. Olson

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David Olson, MD

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I would be happy to attempt to answer any questions about general pediatric topics, either medical issues or behavioral issues. This would include all the various questions one receives in a busy pediatric practice. I`m a board certified pediatrician in northern Michigan and have been in practice for over 15 years. I enjoy the teaching role I have in our practice and would enjoy the opportunity to help others with their pediatric problems.

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